Klara Klein, MD, PhD, a fellow in the division of endocrinology and metabolism, recently published “The Trials and Tribulations of Determining HbA1c Targets For Diabetes Mellitus,” in Nature Reviews Endocrinology, the highest impact journal in endocrinology.
Following is a summary of the review, published with John Buse, MD, PhD, chief of the division of endocrinology.
Guidelines from diabetes care organizations recommend conflicting HbA1c targets — generally between 6.5% and 8%. However, all such organizations advocate for individualization of HbA1c targets, leaving both health-care providers and their patients confused about what HbA1c target is appropriate in an individual patient.
The authors outline the landmark T1DM and T2DM trials that informed the current guidelines, discuss the evidence that drives individualized HbA1c targets, examine the limitations of HbA1c, and consider alternatives for monitoring glycaemic control. Ultimately, in synthesizing this literature, they argue for an HbA1c target of <7% for most individuals, but emphasize the importance of helping patients determine their own personal goals and determinants of quality of life that are independent of a particular glycaemic target. They also recognize that as newer technologies and anti-hyperglycaemic therapies emerge, glycaemic targets will continue to evolve.
The review article can be found here.